Surgical instrument with staged application of electrosurgical and ultrasonic energy

ABSTRACT

An apparatus includes a body, a shaft assembly, an end effector, and a control module. The shaft assembly extends distally from the body and includes an acoustic waveguide. The waveguide is configured to acoustically couple with an ultrasonic transducer. The end effector includes an ultrasonic blade, a clamp arm, an electrode, and a sensor. The ultrasonic blade is in acoustic communication with the waveguide. The clamp arm is operable to compress tissue against the ultrasonic blade. The electrode is operable to apply radiofrequency (RF) electrosurgical energy to tissue. The sensor is operable to sense a condition of tissue contacted by the end effector. The control module is operable to control delivery of ultrasonic power and RF electrosurgical energy through the end effector based on data from the sensor.

BACKGROUND

A variety of surgical instruments include an end effector having a bladeelement that vibrates at ultrasonic frequencies to cut and/or sealtissue (e.g., by denaturing proteins in tissue cells). These instrumentsinclude one or more piezoelectric elements that convert electrical powerinto ultrasonic vibrations, which are communicated along an acousticwaveguide to the blade element. The precision of cutting and coagulationmay be controlled by the operator's technique and adjusting the powerlevel, blade edge angle, tissue traction, and blade pressure. The powerlevel used to drove the blade element may be varied (e.g., in real time)based on sensed parameters such as tissue impedance, tissue temperature,tissue thickness, and/or other factors. Some instruments have a clamparm and clamp pad for grasping tissue with the blade element.

Examples of ultrasonic surgical instruments include the HARMONIC ACE®Ultrasonic Shears, the HARMONIC WAVE® Ultrasonic Shears, the HARMONICFOCUS® Ultrasonic Shears, and the HARMONIC SYNERGY® Ultrasonic Blades,all by Ethicon Endo-Surgery, Inc. of Cincinnati, Ohio. Further examplesof such devices and related concepts are disclosed in U.S. Pat. No.5,322,055, entitled “Clamp Coagulator/Cutting System for UltrasonicSurgical Instruments,” issued Jun. 21, 1994, the disclosure of which isincorporated by reference herein; U.S. Pat. No. 5,873,873, entitled“Ultrasonic Clamp Coagulator Apparatus Having Improved Clamp Mechanism,”issued Feb. 23, 1999, the disclosure of which is incorporated byreference herein; U.S. Pat. No. 5,980,510, entitled “Ultrasonic ClampCoagulator Apparatus Having Improved Clamp Arm Pivot Mount,” issued Nov.9, 1999, the disclosure of which is incorporated by reference herein;U.S. Pat. No. 6,283,981, entitled “Method of Balancing AsymmetricUltrasonic Surgical Blades,” issued Sep. 4, 2001, the disclosure ofwhich is incorporated by reference herein; U.S. Pat. No. 6,309,400,entitled “Curved Ultrasonic Blade having a Trapezoidal Cross Section,”issued Oct. 30, 2001, the disclosure of which is incorporated byreference herein; U.S. Pat. No. 6,325,811, entitled “Blades withFunctional Balance Asymmetries for use with Ultrasonic SurgicalInstruments,” issued Dec. 4, 2001, the disclosure of which isincorporated by reference herein; U.S. Pat. No. 6,423,082, entitled“Ultrasonic Surgical Blade with Improved Cutting and CoagulationFeatures,” issued Jul. 23, 2002, the disclosure of which is incorporatedby reference herein; U.S. Pat. No. 6,773,444, entitled “Blades withFunctional Balance Asymmetries for Use with Ultrasonic SurgicalInstruments,” issued Aug. 10, 2004, the disclosure of which isincorporated by reference herein; U.S. Pat. No. 6,783,524, entitled“Robotic Surgical Tool with Ultrasound Cauterizing and CuttingInstrument,” issued Aug. 31, 2004, the disclosure of which isincorporated by reference herein; U.S. Pat. No. 8,057,498, entitled“Ultrasonic Surgical Instrument Blades,” issued Nov. 15, 2011, thedisclosure of which is incorporated by reference herein; U.S. Pat. No.8,461,744, entitled “Rotating Transducer Mount for Ultrasonic SurgicalInstruments,” issued Jun. 11, 2013, the disclosure of which isincorporated by reference herein; U.S. Pat. No. 8,591,536, entitled“Ultrasonic Surgical Instrument Blades,” issued Nov. 26, 2013, thedisclosure of which is incorporated by reference herein; and U.S. Pat.No. 8,623,027, entitled “Ergonomic Surgical Instruments,” issued Jan. 7,2014, the disclosure of which is incorporated by reference herein.

Still further examples of ultrasonic surgical instruments are disclosedin U.S. Pub. No. 2006/0079874, entitled “Clamp pad for Use with anUltrasonic Surgical Instrument,” published Apr. 13, 2006, the disclosureof which is incorporated by reference herein; U.S. Pub. No.2007/0191713, entitled “Ultrasonic Device for Cutting and Coagulating,”published Aug. 16, 2007, the disclosure of which is incorporated byreference herein; U.S. Pub. No. 2007/0282333, entitled “UltrasonicWaveguide and Blade,” published Dec. 6, 2007, the disclosure of which isincorporated by reference herein; U.S. Pub. No. 2008/0200940, entitled“Ultrasonic Device for Cutting and Coagulating,” published Aug. 21,2008, the disclosure of which is incorporated by reference herein; U.S.Pub. No. 2008/0234710, entitled “Ultrasonic Surgical Instruments,”published Sep. 25, 2008, the disclosure of which is incorporated byreference herein; and U.S. Pub. No. 2010/0069940, entitled “UltrasonicDevice for Fingertip Control,” published Mar. 18, 2010, the disclosureof which is incorporated by reference herein.

Some ultrasonic surgical instruments may include a cordless transducersuch as that disclosed in U.S. Pub. No. 2012/0112687, entitled “RechargeSystem for Medical Devices,” published May 10, 2012, the disclosure ofwhich is incorporated by reference herein; U.S. Pub. No. 2012/0116265,entitled “Surgical Instrument with Charging Devices,” published May 10,2012, the disclosure of which is incorporated by reference herein;and/or U.S. Pat. App. No. 61/410,603, filed Nov. 5, 2010, entitled“Energy-Based Surgical Instruments,” the disclosure of which isincorporated by reference herein.

Additionally, some ultrasonic surgical instruments may include anarticulating shaft section. Examples of such ultrasonic surgicalinstruments are disclosed in U.S. Pub. No. 2014/0005701, published Jan.2, 2014, entitled “Surgical Instruments with Articulating Shafts,” thedisclosure of which is incorporated by reference herein; and U.S. Pub.No. 2014/0114334, published Apr. 24, 2014, entitled “Flexible HarmonicWaveguides/Blades for Surgical Instruments,” the disclosure of which isincorporated by reference herein.

Some instruments are operable to seal tissue by applying radiofrequency(RF) electrosurgical energy to the tissue. An example of a surgicalinstrument that is operable to seal tissue by applying RF energy to thetissue is the ENSEAL® Tissue Sealing Device by Ethicon Endo-Surgery,Inc., of Cincinnati, Ohio. Further examples of such devices and relatedconcepts are disclosed in U.S. Pat. No. 6,500,176 entitled“Electrosurgical Systems and Techniques for Sealing Tissue,” issued Dec.31, 2002, the disclosure of which is incorporated by reference herein;U.S. Pat. No. 7,112,201 entitled “Electrosurgical Instrument and Methodof Use,” issued Sep. 26, 2006, the disclosure of which is incorporatedby reference herein; U.S. Pat. No. 7,125,409, entitled “ElectrosurgicalWorking End for Controlled Energy Delivery,” issued Oct. 24, 2006, thedisclosure of which is incorporated by reference herein; U.S. Pat. No.7,169,146 entitled “Electrosurgical Probe and Method of Use,” issuedJan. 30, 2007, the disclosure of which is incorporated by referenceherein; U.S. Pat. No. 7,186,253, entitled “Electrosurgical Jaw Structurefor Controlled Energy Delivery,” issued Mar. 6, 2007, the disclosure ofwhich is incorporated by reference herein; U.S. Pat. No. 7,189,233,entitled “Electrosurgical Instrument,” issued Mar. 13, 2007, thedisclosure of which is incorporated by reference herein; U.S. Pat. No.7,220,951, entitled “Surgical Sealing Surfaces and Methods of Use,”issued May 22, 2007, the disclosure of which is incorporated byreference herein; U.S. Pat. No. 7,309,849, entitled “PolymerCompositions Exhibiting a PTC Property and Methods of Fabrication,”issued Dec. 18, 2007, the disclosure of which is incorporated byreference herein; U.S. Pat. No. 7,311,709, entitled “ElectrosurgicalInstrument and Method of Use,” issued Dec. 25, 2007, the disclosure ofwhich is incorporated by reference herein; U.S. Pat. No. 7,354,440,entitled “Electrosurgical Instrument and Method of Use,” issued Apr. 8,2008, the disclosure of which is incorporated by reference herein; U.S.Pat. No. 7,381,209, entitled “Electrosurgical Instrument,” issued Jun.3, 2008, the disclosure of which is incorporated by reference herein.

Some instruments are capable of applying both ultrasonic energy andradiofrequency (RF) electrosurgical energy to tissue. Examples of suchinstruments are described in U.S. Pub. No. 2015/0141981, entitled“Ultrasonic Surgical Instrument with Electrosurgical Feature,” publishedMay 21, 2015, the disclosure of which is incorporated by referenceherein; and U.S. Pat. No. 8,663,220, entitled “UltrasonicElectrosurgical Instruments,” issued Mar. 4, 2014, the disclosure ofwhich is incorporated by reference herein.

While several surgical instruments and systems have been made and used,it is believed that no one prior to the inventors has made or used theinvention described in the appended claims.

BRIEF DESCRIPTION OF THE DRAWINGS

While the specification concludes with claims which particularly pointout and distinctly claim this technology, it is believed this technologywill be better understood from the following description of certainexamples taken in conjunction with the accompanying drawings, in whichlike reference numerals identify the same elements and in which:

FIG. 1 depicts a block schematic view of an exemplary surgical system;

FIG. 2 depicts a side elevational view of an exemplary surgicalinstrument that may be incorporated into the system of FIG. 1;

FIG. 3 depicts a cross-sectional side view of an end effector of theinstrument of FIG. 2 in a closed position;

FIG. 4 depicts a cross-sectional side view of the end effector of FIG. 3in an open position;

FIG. 5 depicts a graph showing a plot of tissue temperature versus timeduring activation of the end effector of FIG. 3;

FIG. 6 depicts a schematic view of an exemplary arrangement of poweredcomponents that may be provided in a modified version of the instrumentof FIG. 2;

FIG. 7 depicts a perspective view of an exemplary alternative endeffector that may be incorporated into the instrument of FIG. 2 toprovide the arrangement of powered components of FIG. 6;

FIG. 8 depicts a cross-sectional end view of the end effector of FIG. 7clamping tissue;

FIG. 9 depicts a perspective view of another exemplary alternative endeffector that may be incorporated into the instrument of FIG. 2 toprovide the arrangement of powered components of FIG. 6;

FIG. 10 depicts a cross-sectional end view of the end effector of FIG. 9clamping tissue;

FIG. 11 depicts a graph showing an exemplary activation scheme that maybe carried out using the arrangement of powered components of FIG. 6;

FIG. 12 depicts a graph showing a plot of tissue temperature versus timeduring execution of the activation scheme of FIG. 11;

FIG. 13 depicts a graph showing an exemplary alternative activationscheme that may be carried out using the arrangement of poweredcomponents of FIG. 6; and

FIG. 14 depicts a graph showing another exemplary alternative activationscheme that may be carried out using the arrangement of poweredcomponents of FIG. 6.

The drawings are not intended to be limiting in any way, and it iscontemplated that various embodiments of the technology may be carriedout in a variety of other ways, including those not necessarily depictedin the drawings. The accompanying drawings incorporated in and forming apart of the specification illustrate several aspects of the presenttechnology, and together with the description serve to explain theprinciples of the technology; it being understood, however, that thistechnology is not limited to the precise arrangements shown.

DETAILED DESCRIPTION

The following description of certain examples of the technology shouldnot be used to limit its scope. Other examples, features, aspects,embodiments, and advantages of the technology will become apparent tothose skilled in the art from the following description, which is by wayof illustration, one of the best modes contemplated for carrying out thetechnology. As will be realized, the technology described herein iscapable of other different and obvious aspects, all without departingfrom the technology. Accordingly, the drawings and descriptions shouldbe regarded as illustrative in nature and not restrictive.

It is further understood that any one or more of the teachings,expressions, embodiments, examples, etc. described herein may becombined with any one or more of the other teachings, expressions,embodiments, examples, etc. that are described herein. Thefollowing-described teachings, expressions, embodiments, examples, etc.should therefore not be viewed in isolation relative to each other.Various suitable ways in which the teachings herein may be combined willbe readily apparent to those of ordinary skill in the art in view of theteachings herein. Such modifications and variations are intended to beincluded within the scope of the claims.

For clarity of disclosure, the terms “proximal” and “distal” are definedherein relative to an operator or other operator grasping a surgicalinstrument having a distal surgical end effector. The term “proximal”refers the position of an element closer to the operator or otheroperator and the term “distal” refers to the position of an elementcloser to the surgical end effector of the surgical instrument andfurther away from the operator or other operator.

I. OVERVIEW OF EXEMPLARY ULTRASONIC SURGICAL SYSTEM

FIG. 1 shows components of an exemplary surgical system (10) indiagrammatic block form. As shown, system (10) comprises an ultrasonicgenerator (12) and an ultrasonic surgical instrument (20). As will bedescribed in greater detail below, instrument (20) is operable to cuttissue and seal or weld tissue (e.g., a blood vessel, etc.)substantially simultaneously, using ultrasonic vibrational energy.Generator (12) and instrument (20) are coupled together via cable (14).Cable (14) may comprise a plurality of wires; and may provideunidirectional electrical communication from generator (12) toinstrument (20) and/or bidirectional electrical communication betweengenerator (12) and instrument (20). By way of example only, cable (14)may comprise a “hot” wire for electrical power to surgical instrument(20), a ground wire, and a signal wire for transmitting signals fromsurgical instrument (20) to ultrasonic generator (12), with a shieldsurrounding the three wires. In some versions, separate “hot” wires areused for separate activation voltages (e.g., one “hot” wire for a firstactivation voltage and another “hot” wire for a second activationvoltage, or a variable voltage between the wires proportional to thepower requested, etc.). Of course, any other suitable number orconfiguration of wires may be used. It should also be understood thatsome versions of system (10) may incorporate generator (12) intoinstrument (20), such that cable (14) may simply be omitted.

By way of example only, generator (12) may comprise the GEN04, GEN11, orGEN 300 sold by Ethicon Endo-Surgery, Inc. of Cincinnati, Ohio. Inaddition or in the alternative, generator (12) may be constructed inaccordance with at least some of the teachings of U.S. Pub. No.2011/0087212, entitled “Surgical Generator for Ultrasonic andElectrosurgical Devices,” published Apr. 14, 2011, the disclosure ofwhich is incorporated by reference herein. Alternatively, any othersuitable generator (12) may be used. As will be described in greaterdetail below, generator (12) is operable to provide power to instrument(20) to perform ultrasonic surgical procedures.

Instrument (20) comprises a handle assembly (22), which is configured tobe grasped in one hand (or two hands) of an operator and manipulated byone hand (or two hands) of the operator during a surgical procedure. Forinstance, in some versions, handle assembly (22) may be grasped like apencil by the operator. In some other versions, handle assembly (22) mayinclude a scissor grip that may be grasped like scissors by theoperator. In some other versions, handle assembly (22) may include apistol grip that may be grasped like a pistol by the operator. Ofcourse, handle assembly (22) may be configured to be gripped in anyother suitable fashion. Furthermore, some versions of instrument (20)may substitute handle assembly (22) with a body that is coupled to arobotic surgical system that is configured to operate instrument (20)(e.g., via remote control, etc.). In the present example, a blade (24)extends distally from the handle assembly (22). Handle assembly (22)includes an ultrasonic transducer (26) and an ultrasonic waveguide (28),which couples ultrasonic transducer (26) with blade (24). Ultrasonictransducer (26) receives electrical power from generator (12) via cable(14). By virtue of its piezoelectric properties, ultrasonic transducer(26) is operable to convert such electrical power into ultrasonicvibrational energy.

Ultrasonic waveguide (28) may be flexible, semi-flexible, rigid, or haveany other suitable properties. As noted above, ultrasonic transducer(26) is integrally coupled with blade (24) via ultrasonic waveguide(28). In particular, when ultrasonic transducer (26) is activated tovibrate at ultrasonic frequencies, such vibrations are communicatedthrough ultrasonic waveguide (28) to blade (24), such that blade (24)will also vibrate at ultrasonic frequencies. When blade (24) is in anactivated state (i.e., vibrating ultrasonically), blade (24) is operableto effectively cut through tissue and seal tissue. Ultrasonic transducer(26), ultrasonic waveguide (28), and blade (24) together thus form anacoustic assembly providing ultrasonic energy for surgical procedureswhen powered by generator (12). Handle assembly (22) is configured tosubstantially isolate the operator from the vibrations of the acousticassembly formed by transducer (26), ultrasonic waveguide (28), and blade(24).

In some versions, ultrasonic waveguide (28) may amplify the mechanicalvibrations transmitted through ultrasonic waveguide (28) to blade (24).Ultrasonic waveguide (28) may further have features to control the gainof the longitudinal vibration along ultrasonic waveguide (28) and/orfeatures to tune ultrasonic waveguide (28) to the resonant frequency ofsystem (10). For instance, ultrasonic waveguide (28) may have anysuitable cross-sectional dimensions/configurations, such as asubstantially uniform cross-section, be tapered at various sections, betapered along its entire length, or have any other suitableconfiguration. Ultrasonic waveguide (28) may, for example, have a lengthsubstantially equal to an integral number of one-half system wavelengths(nλ/2). Ultrasonic waveguide (28) and blade (24) may be fabricated froma solid core shaft constructed out of a material or combination ofmaterials that propagates ultrasonic energy efficiently, such astitanium alloy (i.e., Ti-6Al-4V), aluminum alloys, sapphire, stainlesssteel, or any other acoustically compatible material or combination ofmaterials.

In the present example, the distal end of blade (24) is located at aposition corresponding to an anti-node associated with resonantultrasonic vibrations communicated through waveguide (28) (i.e., at anacoustic anti-node), in order to tune the acoustic assembly to apreferred resonant frequency f_(o) when the acoustic assembly is notloaded by tissue. When transducer (26) is energized, the distal end ofblade (24) is configured to move longitudinally in the range of, forexample, approximately 10 to 500 microns peak-to-peak, and in someinstances in the range of about 20 to about 200 microns at apredetermined vibratory frequency f_(o) of, for example, 55.5 kHz. Whentransducer (26) of the present example is activated, these mechanicaloscillations are transmitted through waveguide (28) to reach blade (24),thereby providing oscillation of blade (24) at the resonant ultrasonicfrequency. Thus, the ultrasonic oscillation of blade (24) maysimultaneously sever the tissue and denature the proteins in adjacenttissue cells, thereby providing a coagulative effect with relativelylittle thermal spread. In some versions, an electrical current may alsobe provided through blade (24) to also cauterize the tissue.

By way of example only, ultrasonic waveguide (28) and blade (24) maycomprise components sold under product codes SNGHK and SNGCB by EthiconEndo-Surgery, Inc. of Cincinnati, Ohio. By way of further example only,ultrasonic waveguide (28) and/or blade (24) may be constructed andoperable in accordance with the teachings of U.S. Pat. No. 6,423,082,entitled “Ultrasonic Surgical Blade with Improved Cutting andCoagulation Features,” issued Jul. 23, 2002, the disclosure of which isincorporated by reference herein. As another merely illustrativeexample, ultrasonic waveguide (28) and/or blade (24) may be constructedand operable in accordance with the teachings of U.S. Pat. No.5,324,299, entitled “Ultrasonic Scalpel Blade and Methods ofApplication,” issued Jun. 28, 1994, the disclosure of which isincorporated by reference herein. Other suitable properties andconfigurations of ultrasonic waveguide (28) and blade (24) will beapparent to those of ordinary skill in the art in view of the teachingsherein.

Handle assembly (22) of the present example also includes a controlselector (30) and an activation switch (32), which are each incommunication with a circuit board (34). By way of example only, circuitboard (34) may comprise a conventional printed circuit board, a flexcircuit, a rigid-flex circuit, or may have any other suitableconfiguration. Control selector (30) and activation switch (32) may bein communication with circuit board (34) via one or more wires, tracesformed in a circuit board or flex circuit, and/or in any other suitablefashion. Circuit board (34) is coupled with cable (14), which is in turncoupled with control circuitry (16) within generator (12). Activationswitch (32) is operable to selectively activate power to ultrasonictransducer (26). In particular, when switch (32) is activated, suchactivation provides communication of appropriate power to ultrasonictransducer (26) via cable (14). By way of example only, activationswitch (32) may be constructed in accordance with any of the teachingsof the various references cited herein. Other various forms thatactivation switch (32) may take will be apparent to those of ordinaryskill in the art in view of the teachings herein.

In the present example, surgical system (10) is operable to provide atleast two different levels or types of ultrasonic energy (e.g.,different frequencies and/or amplitudes, etc.) at blade (24). To thatend, control selector (30) is operable to permit the operator to selecta desired level/amplitude of ultrasonic energy. By way of example only,control selector (30) may be constructed in accordance with any of theteachings of the various references cited herein. Other various formsthat control selector (30) may take will be apparent to those ofordinary skill in the art in view of the teachings herein. In someversions, when an operator makes a selection through control selector(30), the operator's selection is communicated back to control circuitry(16) of generator (12) via cable (14), and control circuitry (16)adjusts the power communicated from generator (12) accordingly the nexttime the operator actuates activation switch (32).

It should be understood that the level/amplitude of ultrasonic energyprovided at blade (24) may be a function of characteristics of theelectrical power communicated from generator (12) to instrument (20) viacable (14). Thus, control circuitry (16) of generator (12) may provideelectrical power (via cable (14)) having characteristics associated withthe ultrasonic energy level/amplitude or type selected through controlselector (30). Generator (12) may thus be operable to communicatedifferent types or degrees of electrical power to ultrasonic transducer(26), in accordance with selections made by the operator via controlselector (30). In particular, and by way of example only, generator (12)may increase the voltage and/or current of the applied signal toincrease the longitudinal amplitude of the acoustic assembly. As amerely illustrative example, generator (12) may provide selectabilitybetween a “level 1” and a “level 5,” which may correspond with a blade(24) vibrational resonance amplitude of approximately 50 microns andapproximately 90 microns, respectively. Various ways in which controlcircuitry (16) may be configured will be apparent to those of ordinaryskill in the art in view of the teachings herein. It should also beunderstood that control selector (30) and activation switch (32) may besubstituted with two or more activation switches (32). In some suchversions, one activation switch (32) is operable to activate blade (24)at one power level/type while another activation switch (32) is operableto activate blade (24) at another power level/type, etc.

In some alternative versions, control circuitry (16) is located withinhandle assembly (22). For instance, in some such versions, generator(12) only communicates one type of electrical power (e.g., just onevoltage and/or current available) to handle assembly (22), and controlcircuitry (16) within handle assembly (22) is operable to modify theelectrical power (e.g., the voltage of the electrical power), inaccordance with selections made by the operator via control selector(30), before the electrical power reaches ultrasonic transducer (26).Furthermore, generator (12) may be incorporated into handle assembly(22) along with all other components of surgical system (10). Forinstance, one or more batteries (not shown) or other portable sources ofpower may be provided in handle assembly (22). Still other suitable waysin which the components depicted in FIG. 1 may be rearranged orotherwise configured or modified will be apparent to those of ordinaryskill in the art in view of the teachings herein.

II. OVERVIEW OF EXEMPLARY ULTRASONIC SURGICAL INSTRUMENT

The following discussion relates to various exemplary components andconfigurations of instrument (20). It should be understood that thevarious examples of instrument (20) described below may be readilyincorporated into surgical system (10) as described above. It shouldalso be understood that the various components and operabilities ofinstrument (20) described above may be readily incorporated into theexemplary versions of instrument (20) described below. Various suitableways in which the above and below teachings may be combined will beapparent to those of ordinary skill in the art in view of the teachingsherein. It should also be understood that the below teachings may bereadily combined with the various teachings of the references that arecited herein.

FIGS. 2-4 illustrate an exemplary ultrasonic surgical instrument (100).At least part of instrument (100) may be constructed and operable inaccordance with at least some of the teachings of U.S. Pat. Nos.5,322,055; 5,873,873; 5,980,510; 6,325,811; 6,773,444; 6,783,524;8,461,744; 8,623,027; U.S. Pub. No. 2006/0079874; U.S. Pub. No.2007/0191713; U.S. Pub. No. 2007/0282333; U.S. Pub. No. 2008/0200940;U.S. Pub. No. 2010/0069940; U.S. Pub. No. 2012/0112687; U.S. Pub. No.2012/0116265; U.S. Pub. No. 2014/0005701; U.S. Pub. No. 2014/0114334;U.S. Pat. App. No. 61/410,603; and/or U.S. patent application Ser. No.14/028,717. The disclosures of each of the foregoing patents,publications, and applications are incorporated by reference herein. Asdescribed therein and as will be described in greater detail below,instrument (100) is operable to cut tissue and seal or weld tissue(e.g., a blood vessel, etc.) substantially simultaneously. It shouldalso be understood that instrument (100) may have various structural andfunctional similarities with the HARMONIC ACE® Ultrasonic Shears, theHARMONIC WAVE® Ultrasonic Shears, the HARMONIC FOCUS® Ultrasonic Shears,and/or the HARMONIC SYNERGY® Ultrasonic Blades. Furthermore, instrument(100) may have various structural and functional similarities with thedevices taught in any of the other references that are cited andincorporated by reference herein.

To the extent that there is some degree of overlap between the teachingsof the references cited herein, the HARMONIC ACE® Ultrasonic Shears, theHARMONIC WAVE® Ultrasonic Shears, the HARMONIC FOCUS® Ultrasonic Shears,and/or the HARMONIC SYNERGY® Ultrasonic Blades, and the followingteachings relating to instrument (100), there is no intent for any ofthe description herein to be presumed as admitted prior art. Severalteachings herein will in fact go beyond the scope of the teachings ofthe references cited herein and the HARMONIC ACE® Ultrasonic Shears, theHARMONIC WAVE® Ultrasonic Shears, the HARMONIC FOCUS® Ultrasonic Shears,and the HARMONIC SYNERGY® Ultrasonic Blades.

Instrument (100) of the present example comprises a handle assembly(120), a shaft assembly (130), and an end effector (140). Handleassembly (120) comprises a body (122) including a pistol grip (124) anda pair of buttons (126). Handle assembly (120) also includes a trigger(128) that is pivotable toward and away from pistol grip (124). Itshould be understood, however, that various other suitableconfigurations may be used, including but not limited to a pencil-gripconfiguration or a scissor-grip configuration. End effector (140)includes an ultrasonic blade (160) and a pivoting clamp arm (144). Clamparm (144) is coupled with trigger (128) such that clamp arm (144) ispivotable toward ultrasonic blade (160) in response to pivoting oftrigger (128) toward pistol grip (124); and such that clamp arm (144) ispivotable away from ultrasonic blade (160) in response to pivoting oftrigger (128) away from pistol grip (124). Various suitable ways inwhich clamp arm (144) may be coupled with trigger (128) will be apparentto those of ordinary skill in the art in view of the teachings herein.In some versions, one or more resilient members are used to bias clamparm (144) and/or trigger (128) to the open position shown in FIG. 4.

An ultrasonic transducer assembly (112) extends proximally from body(122) of handle assembly (120). Transducer assembly (112) is coupledwith a generator (116) via a cable (114). Transducer assembly (112)receives electrical power from generator (116) and converts that powerinto ultrasonic vibrations through piezoelectric principles. Generator(116) may include a power source and control module that is configuredto provide a power profile to transducer assembly (112) that isparticularly suited for the generation of ultrasonic vibrations throughtransducer assembly (112). By way of example only, generator (116) maycomprise a GEN04, GEN11, or GEN 300 sold by Ethicon Endo-Surgery, Inc.of Cincinnati, Ohio. In addition or in the alternative, generator (116)may be constructed in accordance with at least some of the teachings ofU.S. Pub. No. 2011/0087212, entitled “Surgical Generator for Ultrasonicand Electrosurgical Devices,” published Apr. 14, 2011, the disclosure ofwhich is incorporated by reference herein. It should also be understoodthat at least some of the functionality of generator (116) may beintegrated into handle assembly (120), and that handle assembly (120)may even include a battery or other on-board power source such thatcable (114) is omitted. Still other suitable forms that generator (116)may take, as well as various features and operabilities that generator(116) may provide, will be apparent to those of ordinary skill in theart in view of the teachings herein.

Blade (160) of the present example is operable to vibrate at ultrasonicfrequencies in order to effectively cut through and seal tissue,particularly when the tissue is being clamped between clamp arm (144)and blade (160). Blade (160) is positioned at the distal end of anacoustic drivetrain. This acoustic drivetrain includes transducerassembly (112) and an acoustic waveguide (102). Transducer assembly(112) includes a set of piezoelectric discs (not shown) located proximalto a horn (not shown) of rigid acoustic waveguide (102). Thepiezoelectric discs are operable to convert electrical power intoultrasonic vibrations, which are then transmitted along acousticwaveguide (102), which extends through shaft assembly (130), to blade(160) in accordance with known configurations and techniques. By way ofexample only, this portion of the acoustic drivetrain may be configuredin accordance with various teachings of various references that arecited herein.

Waveguide (102) is secured within shaft assembly (130) via a pin (133),which passes through waveguide (102) and shaft assembly (130). Pin (133)is located at a position along the length of waveguide (102)corresponding to a node associated with resonant ultrasonic vibrationscommunicated through waveguide (102). When ultrasonic blade (160) is inan activated state (i.e., vibrating ultrasonically), ultrasonic blade(160) is operable to effectively cut through and seal tissue,particularly when the tissue is being clamped between clamp arm (144)and ultrasonic blade (160). It should be understood that waveguide (102)may be configured to amplify mechanical vibrations transmitted throughwaveguide (102). Furthermore, waveguide (102) may include featuresoperable to control the gain of the longitudinal vibrations alongwaveguide (102) and/or features to tune waveguide (102) to the resonantfrequency of the system.

In the present example, the distal end of blade (160) is located at aposition corresponding to an anti-node associated with resonantultrasonic vibrations communicated through waveguide (102), in order totune the acoustic assembly to a preferred resonant frequency f_(o) whenthe acoustic assembly is not loaded by tissue. When transducer assembly(112) is energized, the distal end of blade (160) is configured to movelongitudinally in the range of, for example, approximately 10 to 500microns peak-to-peak, and in some instances in the range of about 20 toabout 200 microns at a predetermined vibratory frequency f_(o) of, forexample, 50 kHz or 55.5 kHz. When transducer assembly (112) of thepresent example is activated, these mechanical oscillations aretransmitted through waveguide (102) to reach blade (160), therebyproviding oscillation of blade (160) at the resonant ultrasonicfrequency. Thus, when tissue is secured between blade (160) and clamparm (144), the ultrasonic oscillation of blade (160) may simultaneouslysever the tissue and denature the proteins in adjacent tissue cells,thereby providing a coagulative effect with relatively little thermalspread. In some versions, an electrical current may also be providedthrough blade (160) and clamp arm (144) to also cauterize the tissue.While some configurations for an acoustic transmission assembly andtransducer assembly (112) have been described, still other suitableconfigurations for an acoustic transmission assembly and transducerassembly (112) will be apparent to one or ordinary skill in the art inview of the teachings herein. Similarly, other suitable configurationsfor end effector (140) will be apparent to those of ordinary skill inthe art in view of the teachings herein.

An operator may activate buttons (126) to selectively activatetransducer assembly (112) to activate blade (160). In the presentexample, two buttons (126) are provided—one for activating blade (160)at a low power and another for activating blade (160) at a high power.However, it should be understood that any other suitable number ofbuttons and/or otherwise selectable power levels may be provided. Forinstance, a foot pedal may be provided to selectively activatetransducer assembly (112). Buttons (126) of the present example arepositioned such that an operator may readily fully operate instrument(100) with a single hand. For instance, the operator may position theirthumb about pistol grip (124), position their middle, ring, and/orlittle finger about trigger (128), and manipulate buttons (126) usingtheir index finger. Of course, any other suitable techniques may be usedto grip and operate instrument (100); and buttons (126) may be locatedat any other suitable positions.

Shaft assembly (130) of the present example comprises an outer sheath(132), an inner tube (134) slidably disposed within outer sheath (132),and a waveguide (102) disposed within inner tube (134). As will bediscussed in more detail below inner tube (134) is operable to translatelongitudinally within outer sheath (132) relative to outer sheath (132)to selectively pivot clamp arm (144) toward and away from blade (160).Shaft assembly (130) of the present example further includes a rotationassembly (150). Rotation assembly (150) is operable to rotate the entireshaft assembly (130) and end effector (140) relative to handle assembly(120) about a longitudinal axis of shaft assembly (130). In someversions, rotation assembly (150) is operable to selectively lock theangular position of shaft assembly (130) and end effector (140) relativeto handle assembly (120) about the longitudinal axis of shaft assembly(130). For instance, a rotation knob (152) of rotation assembly (150)may be translatable between a first longitudinal position, in whichshaft assembly (130) and end effector (140) are rotatable relative tohandle assembly (120) about the longitudinal axis of shaft assembly(130); and a second longitudinal position, in which shaft assembly (130)and end effector (140) are not rotatable relative to handle assembly(120) about the longitudinal axis of shaft assembly (130). Of course,shaft assembly (130) may have a variety of other components, features,and operabilities, in addition to or in lieu of any of those notedabove. Other suitable configurations for shaft assembly (130) will beapparent to those of ordinary skill in the art in view of the teachingsherein.

As shown in FIGS. 3 and 4, end effector (140) includes ultrasonic blade(160) and clamp arm (144). Clamp arm (144) includes a clamp pad (146)secured to an underside of clamp arm (144), facing blade (160). By wayof example only, clamp pad (146) may be formed of apolytetrafluoroethylene (PTFE) material and/or any other suitablematerial(s). By way of further example only, clamp pad (146) may befurther constructed and operable in accordance with at least some of theteachings of U.S. Pat. No. 7,544,200, entitled “Combination Tissue Padfor Use with an Ultrasonic Surgical Instrument,” issued Jun. 9, 2009,the disclosure of which is incorporated by reference herein.

Clamp arm (144) is pivotably coupled with a distal end of outer sheath(132) of shaft assembly (130) above ultrasonic blade (160) via a pin(145). As best seen in FIG. 4, a distal end of inner tube (134) isrotatably coupled with a proximal end of clamp arm (144) belowultrasonic blade (160) via a pin (135) such that longitudinaltranslation of inner tube (134) causes rotation of clamp arm (144) aboutpin (145) toward and away from ultrasonic blade (160) to thereby clamptissue between clamp arm (144) and ultrasonic blade (160) to cut and/orseal the tissue. In particular, proximal longitudinal translation ofinner tube (134) relative to outer sheath (132) and handle assembly(120) causes clamp arm (144) to move toward ultrasonic blade (160); anddistal longitudinal translation of inner tube (134) relative to outersheath (132) and handle assembly (120) causes clamp arm (144) to moveaway from ultrasonic blade (160).

In the present example, trigger (128) is pivotably coupled to handleassembly (120) and is further coupled with inner tube (134). Inparticular, pivoting of trigger (128) toward pistol grip (124) willcause proximal longitudinal translation of inner tube (134) relative toouter sheath (132) and handle assembly (120); and pivoting of trigger(128) away from pistol grip (124) will cause distal longitudinaltranslation of inner tube (134) relative to outer sheath (132) andhandle assembly (120). Finally, because longitudinal translation ofinner tube (134) causes rotation of clamp arm (144) toward and away fromblade (160) as discussed above, it should be understood that pivoting oftrigger (128) toward pistol grip (124) will cause clamp arm (144) tomove toward ultrasonic blade (160); and that pivoting of trigger (128)away from pistol grip (124) will cause clamp arm (144) to move away fromultrasonic blade (160). Various suitable components and features thatmay be used to couple trigger (128) with inner tube (134) to providethis operation are disclosed in several of the references cited herein.Other suitable components and features that may be used to coupletrigger (128) with inner tube (134) to provide this operation will beapparent to those of ordinary skill in the art in view of the teachingsherein. It should also be understood that, in some variations, trigger(128) is operable to drive outer sheath (132) longitudinally while innertube (134) remains stationary. In such versions, the translation ofouter sheath (132) relative to inner tube (134) will similarly causeclamp arm (144) to pivot toward and away from ultrasonic blade (160).

FIG. 5 shows an exemplary graph (200) plotting tissue temperature (202)over the course of time while the tissue is clamped between clamp arm(144) and blade (160), with blade (160) being ultrasonically activated.The origin of this graph (200) represents the moment at which blade(160) is ultrasonically activated while the tissue is clamped betweenclamp arm (144) and blade (160). Line (204) represents the temperaturelevel at which the tissue will begin to seal in response to theultrasonic energy applied by blade (160). Similarly, line (206)represents the time at which the tissue begins to seal in response tothe ultrasonic energy applied by blade (160). Line (208) represents thetime at which the sealing of the tissue is complete. It should thereforebe understood that the distance between lines (206, 208) represents aduration of time in which the tissue is being sealed by end effector(140).

It should also be understood that, in the present example, thetemperature of the tissue continues to increase during the durationrepresented by the space between lines (206, 208). In some alternativeversions, end effector (140) may include sensing capabilities such thatend effector (140) is capable of maintaining the tissue temperature(202) substantially at the level associated with line (204) during theact of sealing (i.e., for the duration represented between line (206)and line (208)). In other words, the sensing capabilities may preventthe tissue from being overheated. Such sensing may be provided inaccordance with the teachings of one or more references cited herein.

It should also be understood that, regardless of whether the temperatureof the tissue continues to increase or stays generally flat for theduration represented between line (206) and line (208), such sensing maybe used to automatically deactivate blade (160) once it is determinedthat the tissue has reached an appropriately sealed state (i.e., at themoment in time represented by line (208)). Again, such sensing andresponse may be provided in accordance with the teachings of one or morereferences cited herein.

In addition or in the alternative, the operator may rely on visualobservation and/or tactile feedback through trigger (128) (e.g., feelinga difference in clamping force from clamp arm (144)) to determine whenthe tissue has reached an appropriately sealed state. The operator maythen release the actuated button (126) to deactivate blade (160), andrelease trigger (128) to pivot clamp arm (144) away from the tissue,thereby manually establishing the end of the sealing stage representedby line (208).

The foregoing components and operabilities of instrument (100) aremerely illustrative. Instrument (100) may be configured in numerousother ways as will be apparent to those of ordinary skill in the art inview of the teachings herein. By way of example only, at least part ofinstrument (100) may be constructed and/or operable in accordance withat least some of the teachings of any of the following, the disclosuresof which are all incorporated by reference herein: U.S. Pat. Nos.5,322,055; 5,873,873; 5,980,510; 6,325,811; 6,783,524; U.S. Pub. No.2006/0079874; U.S. Pub. No. 2007/0191713; U.S. Pub. No. 2007/0282333;U.S. Pub. No. 2008/0200940; U.S. Pub. No. 2010/0069940; U.S. Pub. No.2011/0015660; U.S. Pub. No. 2012/0112687; U.S. Pub. No. 2012/0116265;U.S. Pub. No. 2014/0005701; and/or U.S. Pub. No. 2014/0114334.Additional merely illustrative variations for instrument (100) will bedescribed in greater detail below. It should be understood that thebelow described variations may be readily applied to instrument (100)described above and any of the instruments referred to in any of thereferences that are cited herein, among others.

III. EXEMPLARY END EFFECTOR WITH COMBINED ULTRASONIC AND ELECTROSURGICALCAPABILITIES

In some instances where a conventional form of instrument (20, 100) isused, it may take a relatively long time for the tissue to reach atemperature where the tissue begins to seal in response to activation ofblade (160) while the tissue is being clamped between clamp arm (144)and blade (160). In other words, referring back to FIG. 5, the durationbetween the moment when blade (160) is activated and the momentrepresented by line (206) may be relatively long. It may therefore bedesirable to speed up this “pre-heating” time. As described in greaterdetail below, one way in which this “pre-heating” time may be sped up isto apply RF electrosurgical energy to the tissue. As will also bedescribed in greater detail below, this RF electrosurgical energy may beapplied using the same end effector that applies ultrasonic energy tothe tissue. In addition to providing a general combination of RFelectrosurgical and ultrasonic capabilities, the below examples furtherprovide control algorithms that regulate the application of these twodifferent energy modalities to avoid overheating the tissue. Thefollowing examples thus provide enhanced pre-heating capabilitieswithout resulting in overheating.

FIG. 6 shows an arrangement of components that may be used to form asystem (250) that is capable of providing enhanced tissue pre-heatingcapabilities without resulting in overheating of tissue. It should beunderstood that the components and operability of this system (250) maybe readily combined with the components and operability of system (10)described above. System (250) of this example comprises a power source(252), a control module (256), an acoustic drivetrain (258), an RFelectrosurgical drivetrain (260), and a sensor (262).

Power source (252) of the present example is operable to provide theelectrical power to drive acoustic drivetrain (258) and RFelectrosurgical drivetrain (260). Power source (252) is also operable toprovide whatever electrical power is needed in order to render controlmodule (256) operable. By way of example only, power source (252) mayinclude a generator such as generator (12, 116) described above. Asfurther described above, power source (252) may be integrated into asurgical instrument associated with system (250) or may be coupled withthe surgical instrument via a cable such as cable (14, 114), etc.Various suitable forms that power source (252) may take will be apparentto those of ordinary skill in the art in view of the teachings herein.

Control module (256) of the present example may include a microprocessorand/or various other hardware components that are configured to executea control logic. In particular, control module (256) is operable toselectively provide power from power source (252) to acoustic drivetrain(258) and RF electrosurgical drivetrain (260) in accordance with one ormore control algorithms provided through control logic. In versionswhere sensor (262) is present, control module (256) receives data fromsensor (262) and is thereby operable to factor in such data whenexecuting the control logic. In some versions, control module (256) isintegrated into power source (252) (e.g., in a generator (12, 116) thatis separate from a surgical instrument associated with system (250)). Insome other versions, control module (256) is integrated into a surgicalinstrument associated with system (250). Various suitable forms thatcontrol module (256) may take will be apparent to those of ordinaryskill in the art in view of the teachings herein.

Acoustic drivetrain (258) of the present example is operable to generateand communicate ultrasonic vibrations in response to electrical powerfrom power source (252), as regulated by control module (256). By way ofexample only, acoustic drivetrain (258) may comprise an ultrasonictransducer (26, 112), a waveguide (28), and an ultrasonic blade (24,160) as described above. Other suitable forms that acoustic drivetrain(258) may take will be apparent to those of ordinary skill in the art inview of the teachings herein.

RF electrosurgical drivetrain (260) of the present example is operableto apply RF electrosurgical energy to tissue in response to electricalpower from power source (252), as regulated by control module (256). Byway of example only, RF electrosurgical drivetrain (260) may include apair of electrodes and a corresponding pair of electrical conduits(e.g., wires, traces, etc.) that are coupled with control module (256).As described in greater detail below, the electrodes of RFelectrosurgical drivetrain (260) may be integrated into the same endeffector as the ultrasonic blade of acoustic drivetrain (258). Forinstance, a clamp arm such as clamp arm (144) may include twoelectrodes—each providing a different pole for the application ofbipolar energy. As another merely illustrative example, a clamp arm suchas clamp arm (144) may include a single electrode for providing onepole; while an ultrasonic blade such as blade (24, 160) may serve asanother electrode to provide the other pole for application of bipolarenergy. As yet another merely illustrative example, the end effector mayinclude just one electrode (e.g., in a clamp arm such as clamp arm (144)or in an ultrasonic blade such as blade (24, 160)), and a conventionalground pad may be secured to the patient to provide another electrodesuch that the end effector is operable to apply monopolar energy totissue. Other suitable forms that RF electrosurgical drivetrain (260)may take will be apparent to those of ordinary skill in the art in viewof the teachings herein.

Sensor (262) of the present example is operable to sense a state of thetissue that is being engaged by the end effector of the instrumentassociated with system (250). In particular, sensor (262) is operable tosense one or more tissue conditions that would indicate that the tissuehas reached the appropriate sealing temperature associated with line(204) as shown in FIG. 5 and as described above. By way of example only,sensor (262) may comprise a conventional temperature sensor. As anothermerely illustrative example, sensor (262) may comprise an impedancesensor (e.g., to the extent that the impedance of tissue is indicativeof the tissue reaching an appropriate temperature or otherwise reachinga sealed state). As yet another merely illustrative example, sensor(262) may comprise a positive temperature coefficient (PTC) thermistor.Other suitable forms that sensor (262) may take will be apparent tothose of ordinary skill in the art in view of the teachings herein. Itshould also be understood that sensor (262) may be incorporated into theend effector of the instrument associated with system (250) (e.g., in aclamp arm such as clamp arm (144)), such that the sensor (262) maydirectly contact the tissue that is being engaged by the end effector.In some versions of system (250), sensor (262) is omitted.

The following examples include various end effector configurations thatmay be incorporated into system (250) and various control algorithmsthat may be executed through system (250). In addition to having thefeatures, configurations, and functionalities described below, thefollowing examples may also have any of the various features,configurations, and/or functionalities taught in U.S. Pat. No.8,663,220, entitled “Ultrasonic Electrosurgical Instruments,” issuedMar. 4, 2014, the disclosure of which is incorporated by referenceherein; U.S. Pub. No. 2015/0141981, entitled “Ultrasonic SurgicalInstrument with Electrosurgical Feature,” published May 21, 2015, thedisclosure of which is incorporated by reference herein; and/or U.S.Patent App. No. 62/265,611, entitled “End Effector for Instrument withUltrasonic and Electrosurgical Features,” filed Dec. 11, 2015,disclosure of which is incorporated by reference herein. Varioussuitable ways in which the below teachings may be combined withteachings of those references (and/or combined with the teachings of theother references cited herein) will be apparent to those of ordinaryskill in the art.

A Exemplary End Effector with Clamp Arm Having Electrode Pair

FIGS. 7-8 show an exemplary end effector (300) that may be incorporatedinto instrument (100) in place of end effector (140) in order to providethe functionality of system (250) described above. End effector (340)comprises a clamp arm (330) and an ultrasonic blade (320). End effector(340) is located at the distal end of a shaft assembly (310). Shaftassembly (310) includes an outer tube (312) and an inner tube (314).Clamp arm (330) is pivotably coupled with outer tube (312) and also withinner tube (314), such that clamp arm (330) is configured to pivottoward and away from blade (320) in response to relative movementbetween tubes (312, 314). Clamp arm (330) is thus pivotable just likeclamp arm (144) described above. In some versions, outer tube (312)translates while inner tube (314) remains stationary in order to providepivotal movement of clamp arm (330). In some other versions, inner tube(314) translates while outer tube (312) remains stationary in order toprovide pivotal movement of clamp arm (330). It should also beunderstood that the connections between clamp arm (330) and tubes (312,314) may be reversed such that the main pivot is on inner tube (314)instead of being on outer tube (312).

Blade (320) of the present example is configured and operable just likeblade (24, 160) described above. Alternatively, blade (320) may have anyother suitable configuration. It should be understood that, in thecontext of system (250) described above, blade (320) serves as part ofacoustic drivetrain (258).

Clamp arm (330) of the present example is substantially similar to clamparm (144) described above. In particular, clamp arm (330) comprises aclamp arm body (332) and a clamp pad (334) that is secured to clamp armbody (332) by a rail (350). By way of example only, clamp pad (334) maybe formed of a polytetrafluoroethylene (PTFE) material and/or any othersuitable material(s). Unlike clamp arm (144), clamp arm (330) of thisexample further includes a pair of electrodes (336, 338) and a sensor(340). In the present example, electrodes (336, 338) are configured toprovide opposing poles for application of bipolar RF electrosurgicalenergy to tissue that contacts electrodes (336, 338). In some otherversions, both electrodes (336, 338) provide one pole while blade (320)provides another pole for application of bipolar RF electrosurgicalenergy to tissue that contacts electrodes (336, 338) and blade (320). Ineither case, it should be understood that the material forming clamp pad(334) may have electrically insulative properties to prevent shortcircuiting between electrodes (336, 338). It should also be understoodthat, in the context of system described above, electrodes (336, 338)serve as part of RF electrosurgical drivetrain (260).

In the present example, electrodes (336, 338) extend along the fulllength of clamp pad (334) and are positioned at the laterally outermostregions of clamp pad (334). In some alternative versions, one or both ofelectrodes (336, 338) is/are positioned laterally inwardly from thepositions shown in FIGS. 7-8, such that a portion of clamp pad (334) ispositioned laterally outwardly from electrodes (336, 338). It shouldalso be understood that three or more electrodes may be provided onclamp pad (334). In some versions, a center electrode extendslongitudinally along at least part of the length of clamp pad (334), islaterally centered relative to clamp pad (334), and is recessed relativeto the tissue contacting surfaces of clamp pad (334). Such positioningof an electrode may enable the electrode to contact tissue without beingable to contact blade (320). Such recessing of an electrode may also beapplied to more than one electrode in clamp pad (334), and is notnecessarily limited to a single central electrode. Other suitableconfigurations and arrangements of electrodes (336, 338) will beapparent to those of ordinary skill in the art in view of the teachingsherein.

Sensor (340) of the present example is located at the distal end of endeffector (300) and is laterally positioned between electrodes (336,338). This location is just one merely illustrative example. Othersuitable locations for sensor (340) will be apparent to those ofordinary skill in the art in view of the teachings herein. It shouldalso be understood that end effector (300) may include two or moresensors (340) if desired.

Sensor (340) of the present example is operable to sense a state of thetissue that is being engaged by clamp pad (334). In particular, sensor(340) is operable to sense one or more tissue conditions that wouldindicate that the tissue has reached the appropriate sealing temperatureassociated with line (204) as shown in FIG. 5 and as described above. Byway of example only, sensor (340) may comprise a conventionaltemperature sensor. As another merely illustrative example, sensor (340)may comprise an impedance sensor (e.g., to the extent that the impedanceof tissue is indicative of the tissue reaching an appropriatetemperature or otherwise reaching a sealed state). As yet another merelyillustrative example, sensor (340) may comprise a positive temperaturecoefficient (PTC) thermistor. As still another merely illustrativeexample, sensor (340) may comprise an optical sensor that is capable ofdetermining the state of tissue based on optical sensing of the tissue.Other suitable forms that sensor (340) may take will be apparent tothose of ordinary skill in the art in view of the teachings herein. Itshould be understood that, in the context of system (250) describedabove, sensor (340) serves the purpose of sensor (262).

As shown in FIG. 8, end effector (300) may be used to clamp tissue (T₁,T₂) between clamp arm (330) and blade (320). While end effector (300) isshown as clamping two layers of tissue (T₁, T₂), it should be understoodthat some uses of end effector (300) may include clamping only one layerof tissue (T₁, T₂). In either case, end effector (300) may be activatedto either just seal the tissue (T₁, T₂) or cut and seal the tissue (T₁,T₂). When end effector (300) is activated to apply RF electrosurgicalenergy, the RF electrosurgical energy may flow through the tissue (T₁,T₂) that is positioned between electrodes (336, 338). In addition or inthe alternative, when end effector (300) is activated to apply RFelectrosurgical energy, the RF electrosurgical energy may flow throughthe tissue (T₁, T₂) that is positioned between electrodes (336, 338) andblade (320). When end effector (300) is activated to apply ultrasonicenergy, blade (320) applies the ultrasonic energy to the region oftissue clamped between clamp arm (330) and blade (320). As described ingreater detail below, end effector (300) may apply RF electrosurgicalenergy and ultrasonic energy separately in a sequence; or togethersimultaneously. In either case, control module (256) may determine theappropriate algorithm for applying RF electrosurgical energy and/orultrasonic energy.

While end effector (300) applies RF electrosurgical energy and/orultrasonic energy to the tissue (T₁, T₂), sensor (340) may continuouslydetect one or more conditions associated with the tissue (T₁, T₂) andprovide data to control module (256). Control module (256) may processthis data as a factor of a control algorithm that is used to determinewhether and how to apply RF electrosurgical energy and/or ultrasonicenergy to the tissue (T₁, T₂). Various examples of control algorithmsare described in greater detail below, while other examples of controlalgorithms will be apparent to those of ordinary skill in the art inview of the teachings herein.

In some versions, electrodes (336, 338) comprise PTC material. In somesuch versions, electrodes (336, 338) provide a resistance value thatincreases as the temperature of the tissue (T₁, T₂) increases. In somesuch versions, as the resistance of electrodes (336, 338) increases inresponse to the temperature of the tissue (T₁, T₂) increasing, the RFelectrosurgical energy provided by electrodes (336, 338) diminishes,perhaps even ceasing once the temperature of the tissue (T₁, T₂) exceedsa threshold. Thus, in a sense the PTC material of electrodes (336, 338)may serve as a sensor (340) in addition to serving as electrodes, sincethe PTC material is sensitive to the condition of the tissue (T₁, T₂)and effectively changes the delivery of RF electrosurgical energy to thetissue (T₁, T₂) based on the condition of the tissue (T₁, T₂). Ofcourse, electrodes (336, 338) need not necessarily include PTC materialif desired.

For instance, in some other versions, electrodes (336, 338) do notcomprise PTC material but a PTC material is used in sensor (340). Insuch versions, the resistance value of the PTC material forming sensor(340) may still change in response to the temperature of the tissue (T₁,T₂) increasing, and control module (256) may execute a control algorithmto reduce the RF energy delivered through electrodes (336, 338) inresponse to increases in the resistance value of the PTC materialforming sensor (340). As another merely illustrative example, endeffector (300) may include two discrete, spaced-apart sensors (340) thateach comprise PTC material. In some such versions, control module (256)may monitor the resistance value of the PTC material from one sensor(340) to the other sensor (340) through the tissue that is beingcontacted by sensors (340). As yet another merely illustrative variationwhere two sensors (340) are used in this fashion, one sensor (340) maycomprise a PTC material while the other sensor (340) may comprise aconductive non-PTC material that is unaffected by temperaturesencountered during normal operation of end effector (300). Othersuitable variations will be apparent to those of ordinary skill in theart in view of the teachings herein.

B. Exemplary End Effector with Clamp Arm Having Single Electrode

FIGS. 9-10 show another exemplary end effector (400) that may beincorporated into instrument (100) in place of end effector (140) inorder to provide the functionality of system (250) described above. Endeffector (440) comprises a clamp arm (430) and an ultrasonic blade(420). End effector (440) is located at the distal end of a shaftassembly (410). Shaft assembly (410) includes an outer tube (412) and aninner tube (414). Clamp arm (430) is pivotably coupled with outer tube(412) and also with inner tube (414), such that clamp arm (430) isconfigured to pivot toward and away from blade (420) in response torelative movement between tubes (412, 414). Clamp arm (430) is thuspivotable just like clamp arm (144) described above. In some versions,outer tube (412) translates while inner tube (414) remains stationary inorder to provide pivotal movement of clamp arm (430). In some otherversions, inner tube (414) translates while outer tube (412) remainsstationary in order to provide pivotal movement of clamp arm (430).

Blade (420) of the present example is configured and operable just likeblade (24, 160) described above. Alternatively, blade (420) may have anyother suitable configuration. It should be understood that, in thecontext of system (250) described above, blade (420) serves as part ofacoustic drivetrain (258).

Clamp arm (430) of the present example is substantially similar to clamparm (144) described above. In particular, clamp arm (430) comprises aclamp arm body (432) and a clamp pad (434) that is secured to clamp armbody (432) by a rail (450). By way of example only, clamp pad (434) maybe formed of a polytetrafluoroethylene (PTFE) material and/or any othersuitable material(s). Unlike clamp arm (144), clamp arm (430) of thisexample further includes an electrode (436) and a sensor (440). In thepresent example, electrode (436) is configured to provide one pole forapplication of bipolar RF electrosurgical energy while blade (420)provides another pole for application of bipolar RF electrosurgicalenergy to tissue that contacts electrode (436) and blade (420). Itshould be understood that, in the context of system described above,electrode (436) and blade (420) together serve as part of RFelectrosurgical drivetrain (260).

In the present example, electrode (436) defines a “U” shape and extendsalong a substantial portion of the full length of clamp pad (434). Inaddition, electrode (436) is positioned inwardly from the outermostregions of clamp pad (434). In some alternative versions, electrode(436) extends along the outermost regions of clamp pad (434). As anothermerely illustrative example, electrode (436) may extend across the fullwidth of clamp pad (434). Other suitable configurations and arrangementsof electrode (436) will be apparent to those of ordinary skill in theart in view of the teachings herein.

Sensor (440) of the present example is located at the distal end of endeffector (400) and is located just distal to electrode (436). Thislocation is just one merely illustrative example. Other suitablelocations for sensor (440) will be apparent to those of ordinary skillin the art in view of the teachings herein. It should also be understoodthat end effector (400) may include two or more sensors (440) ifdesired.

Sensor (440) of the present example is operable to sense a state of thetissue that is being engaged by clamp pad (434). In particular, sensor(440) is operable to sense one or more tissue conditions that wouldindicate that the tissue has reached the appropriate sealing temperatureassociated with line (204) as shown in FIG. 5 and as described above. Byway of example only, sensor (440) may comprise a conventionaltemperature sensor. As another merely illustrative example, sensor (440)may comprise an impedance sensor (e.g., to the extent that the impedanceof tissue is indicative of the tissue reaching an appropriatetemperature or otherwise reaching a sealed state). As yet another merelyillustrative example, sensor (440) may comprise a positive temperaturecoefficient (PTC) thermistor. Other suitable forms that sensor (440) maytake will be apparent to those of ordinary skill in the art in view ofthe teachings herein. It should be understood that, in the context ofsystem (250) described above, sensor (440) serves the purpose of sensor(262).

As shown in FIG. 10, end effector (400) may be used to clamp tissue (T₁,T₂) between clamp arm (430) and blade (420). While end effector (400) isshown as clamping two layers of tissue (T₁, T₂), it should be understoodthat some uses of end effector (400) may include clamping only one layerof tissue (T₁, T₂). In either case, end effector (400) may be activatedto either just seal the tissue (T₁, T₂) or cut and seal the tissue (T₁,T₂). When end effector (400) is activated to apply RF electrosurgicalenergy, the RF electrosurgical energy may flow through the tissue (T₁,T₂) that is positioned between electrode (436) and blade (420). When endeffector (400) is activated to apply ultrasonic energy, blade (420)applies the ultrasonic energy to the region of tissue clamped betweenclamp arm (430) and blade (420). As described in greater detail below,end effector (400) may apply RF electrosurgical energy and ultrasonicenergy separately in a sequence; or together simultaneously. In eithercase, control module (256) may determine the appropriate algorithm forapplying RF electrosurgical energy and/or ultrasonic energy.

While end effector (400) applies RF electrosurgical energy and/orultrasonic energy to the tissue (T₁, T₂), sensor (440) may continuouslydetect one or more conditions associated with the tissue (T₁, T₂) andprovide data to control module (256). Control module (256) may processthis data as a factor of a control algorithm that is used to determinewhether and how to apply RF electrosurgical energy and/or ultrasonicenergy to the tissue (T₁, T₂). Various examples of control algorithmsare described in greater detail below, while other examples of controlalgorithms will be apparent to those of ordinary skill in the art inview of the teachings herein.

In some versions, electrode (436) comprises PTC material. In some suchversions, electrode (436) provides a resistance value that increases asthe temperature of the tissue (T₁, T₂) increases. In some such versions,as the resistance of electrode (436) increases in response to thetemperature of the tissue (T₁, T₂) increasing, the RF electrosurgicalenergy provided by electrode (436) diminishes, perhaps even ceasing oncethe temperature of the tissue (T₁, T₂) exceeds a threshold. Thus, in asense the PTC material of electrode (436) may serve as a sensor (440) inaddition to serving as an electrode, since the PTC material is sensitiveto the condition of the tissue (T₁, T₂) and effectively changes thedelivery of RF electrosurgical energy to the tissue (T₁, T₂) based onthe condition of the tissue (T₁, T₂). Of course, electrode (436) neednot necessarily include PTC material if desired.

For instance, in some other versions, electrode (436) does not comprisePTC material but a PTC material is used in sensor (440). In suchversions, the resistance value of the PTC material forming sensor (440)may still change in response to the temperature of the tissue (T₁, T₂)increasing, and control module (256) may execute a control algorithm toreduce the RF energy delivered through electrode (436) and blade (420)in response to increases in the resistance value of the PTC materialforming sensor (440). As another merely illustrative example, endeffector (400) may include two discrete, spaced-apart sensors (440) thateach comprise PTC material. In some such versions, control module (256)may monitor the resistance value of the PTC material from one sensor(440) to the other sensor (440) through the tissue that is beingcontacted by sensors (440). As yet another merely illustrative variationwhere two sensors (440) are used in this fashion, one sensor (440) maycomprise a PTC material while the other sensor (440) may comprise aconductive non-PTC material that is unaffected by temperaturesencountered during normal operation of end effector (400). Othersuitable variations will be apparent to those of ordinary skill in theart in view of the teachings herein.

C. Exemplary Control Algorithms

The following examples include various control algorithms that may beexecuted through a control logic residing in control module (256) ofsystem (250). It should also be understood that either of the endeffectors (300, 400) described above may be used in the performance ofthese control algorithms. In addition or in the alternative, endeffectors such as those described in U.S. Pat. No. 8,663,220 and/or U.S.Pub. No. 2015/0141981 may be used in the performance of these controlalgorithms. Other suitable end effectors that may be used in theperformance of these control algorithms will be apparent to those ofordinary skill in the art in view of the teachings herein. It should beunderstood that each of the algorithms described below may begin as soonas an operator actuates a button (126) while clamping tissue (T₁, T₂)with end effector (300, 400).

FIG. 11 shows a graph (500) depicting an algorithm whereby an endeffector (300, 400) may apply RF electrosurgical energy and ultrasonicenergy to tissue (T₁, T₂) in a particular sequence and combination. FIG.12 shows a graph (600) plotting tissue temperature (602) over the courseof time while the tissue is clamped between clamp arm (330, 430) andblade (320, 420), during performance of the algorithm depicted in graph(500). In executing the algorithm of the present example, control module(256) first activates end effector (300, 400) to apply RFelectrosurgical energy to the tissue. In graph (500), the RFelectrosurgical energy is represented by the line (502) with spacedapart circles. As shown in FIG. 12, this RF electrosurgical energyprovides a rapid increase in the tissue temperature (602), resulting inthe tissue (T₁, T₂) beginning to seal relatively quickly after thecontrol algorithm is first executed. Line (612) represents thetemperature level at which the tissue (T₁, T₂) will begin to seal.Similarly, line (606) represents the time at which the tissue (T₁, T₂)begins to seal. It should be understood from a comparison between thegraph (200) of FIG. 5 and the graph (600) of FIG. 12 that the tissue(T₁, T₂) will begin to seal much more quickly when RF electrosurgicalenergy is used at the beginning of the process.

In the present example, the control algorithm includes a period ofoverlap where control module (256) activates end effector (300, 400) toapply RF electrosurgical energy and ultrasonic energy simultaneously. Inthe graph (500) of FIG. 11, this occurs at the moment in timerepresented by line (506). In graph (500), the ultrasonic energy isrepresented by the line (504) with spaced apart x's. In the graph (600)of FIG. 12, this occurs at the moment in time represented by line (604).It should therefore be understood that lines (506, 604) represent thesame moment in time. This moment in time is associated with the tissue(T₁, T₂) reaching a temperature level (610) that is just below thetemperature level (612) where sealing actually begins. Once the sealingactually begins, control module (256) ceases application of RFelectrosurgical energy via end effector (300, 400), such that endeffector (300, 400) only applies ultrasonic energy. This transitionoccurs at the moment in time represented by line (508) in graph (500) ofFIG. 11. It should therefore be understood that lines (508, 606)represent the same moment in time.

During the power mode overlap period between the moment represented bylines (506, 604) and the moment represented by lines (508, 606), thepower level of the RF electrosurgical energy may be gradually decreasedto zero. Alternatively, the power level of the RF electrosurgical energymay be constant during the power mode overlap period between the momentrepresented by lines (506, 604) and the moment represented by lines(508, 606). Regardless of whether the power level of the RFelectrosurgical energy remains constant or changes during the power modeoverlap period between the moment represented by lines (506, 604) andthe moment represented by lines (508, 606), the power level of theultrasonic energy may gradually increase or may be immediately activatedat the predetermined power level. When control module (256) ceasesapplication of RF electrosurgical energy via end effector (300, 400),the temperature of the tissue (T₁, T₂) may continue to increase, at arate that will depend on the amount of ultrasonic energy being impartedto the tissue (T₁, T₂) via end effector (300, 400).

It should be understood that the tissue (T₁, T₂) will be actively sealedduring the time period between the moments represented by lines (606,608). As shown in FIG. 12, the tissue temperature (602) continues toincrease during the duration represented by the space between lines(606, 608). However, the rate of increase during this duration is lessthan the rate of increase encountered during the pre-heating stage,which occurs before and up to the moment represented by line (604). Inother words, the tissue heating is more gradual during the durationrepresented by the space between lines (606, 608) than the tissueheating encountered before and up to the moment represented by line(604). In some other versions, the tissue temperature (602) remainssubstantially constant, at the level (612) associated with sealing,during the time period represented by the space between lines (606,608). In some such versions, control module (256) may regulate thedelivery of ultrasonic power through blade (320, 420) in order toprovide substantial constancy in the tissue temperature (602) duringthis period. In some such versions, control module (256) relies onfeedback from sensor (340, 440) in order to regulate the delivery ofultrasonic power through blade (320, 420) in order to providesubstantial constancy in the tissue temperature (602).

Once the tissue (T₁, T₂) has been appropriately sealed, control module(256) may deactivate the ultrasonic power, which may result in adecrease in the tissue temperature (602). The moment in time in whichthe ultrasonic power is deactivated is represented by line (608) in FIG.12. In some versions, this deactivation of ultrasonic power isautomatically provided by control module (256). By way of example only,control module (256) may automatically deactivate ultrasonic power inresponse to data from sensor (340, 440). In addition or in thealternative, control module (256) may automatically deactivateultrasonic power in response to data from a timer and/or some othercomponent. As yet another merely illustrative alternative, ultrasonicpower may be manually deactivated by the operator, such as by releasingan activation button (126).

It should also be understood that control module (256) may automaticallyprovide the power mode transitions at the moments represented by lines(506, 508) in response to data from sensor (340, 440). For instance,when sensor (340, 440) detects that the tissue temperature (602) hassurpassed the first threshold level (610), control module (256) mayrespond by automatically activating ultrasonic energy while maintainingthe activation of RF electrosurgical energy. When sensor (340, 440)detects that tissue temperature (602) has reached the level (612)associated with tissue sealing, control module (256) may respond byautomatically deactivating RF electrosurgical energy while maintainingthe activation of ultrasonic energy. In versions where electrodes (336,338, 436) comprise PTC material, the change in resistance that isprovided by the PTC material may effect the deactivation of RFelectrosurgical energy through end effector (300, 400). In suchversions, control module (256) need not provide any kind of switching todeactivate the RF electrosurgical energy.

In addition to or in lieu of being based on data from sensor (340, 440),the power mode transitions provided by control module (256) may be basedon the passage of time. For instance, control module (256) may execute acontrol algorithm that provides only RF energy to tissue via endeffector (300, 400) for a certain predetermined duration, followed by acombination of RF energy and ultrasonic energy to tissue via endeffector (300, 400) for a subsequent predetermined duration, followed byonly ultrasonic energy to tissue via end effector (300, 400). As anothermerely illustrative example, control module (256) may execute a controlalgorithm that provides only RF energy to tissue via end effector (300,400) for a certain predetermined duration, followed by only ultrasonicenergy to tissue via end effector (300, 400). It should therefore beunderstood that sensor (340, 440) may be omitted in some versions. Asyet another merely illustrative variation, control module (256) may relyon a combination of data from sensor (340, 440) and data from a timer tocombine tissue conditions and time conditions as factors in execution ofa control algorithm to provide power mode transitions through endeffector (300, 400).

The above described power mode transitions may occur while the operatorcontinues to actuate button (126), such that the operator does not needto perform in any separate acts in order to provide these power modetransitions. In some versions, control module (256) may trigger one ormore forms of audible feedback and/or visual feedback to indicate to theoperator that end effector (300, 400) is providing power modetransitions. Various suitable ways in which the operator may receivethis feedback will be apparent to those of ordinary skill in the art inview of the teachings herein.

FIG. 13 shows a graph (700) depicting another algorithm whereby an endeffector (300, 400) may apply RF electrosurgical energy and ultrasonicenergy to tissue (T₁, T₂) in a particular sequence and combination. Inexecuting the algorithm of the present example, control module (256)first activates end effector (300, 400) to apply RF electrosurgicalenergy to the tissue. In graph (700), the RF electrosurgical energy isrepresented by the line (702) with spaced apart circles. As noted aboveand as shown in FIG. 12, this RF electrosurgical energy provides a rapidincrease in the tissue temperature (602), resulting in the tissue (T₁,T₂) beginning to seal relatively quickly after the control algorithm isfirst executed. So again, the tissue (T₁, T₂) will begin to seal muchmore quickly when RF electrosurgical energy is used at the beginning ofthe process as compared to just ultrasonic energy.

Unlike the algorithm shown in graph (500) of FIG. 11, the algorithmshown in graph (700) provides a toggle from RF electrosurgical energy toultrasonic energy, such that there is no period of overlap where RFelectrosurgical energy and ultrasonic energy are applied simultaneously.In graph (700), the ultrasonic energy is represented by the line (704)with spaced apart x's. The moment at which this power mode transitionoccurs is represented by line (706) in graph (700) of FIG. 13. In someversions, this moment represented by line (706) in graph (700) of FIG.13 may coincide with the moment represented by line (604) in graph (600)of FIG. 12. In other words, control module (256) may toggle from only RFelectrosurgical energy to only ultrasonic energy once the tissuetemperature (602) passes a first threshold level (610) that is justbelow the level (612) where tissue sealing actually begins. In someother versions, the moment represented by line (706) in graph (700) ofFIG. 13 may coincide with the moment represented by line (606) in graph(600) of FIG. 12. In other words, control module (256) may toggle fromonly RF electrosurgical energy to only ultrasonic energy once the tissuetemperature (602) reaches the level (612) where tissue sealing actuallybegins.

FIG. 14 shows a graph (800) depicting another algorithm whereby an endeffector (300, 400) may apply RF electrosurgical energy and ultrasonicenergy to tissue (T₁, T₂) in a particular sequence and combination. Inexecuting the algorithm of the present example, control module (256)first activates end effector (300, 400) to apply RF electrosurgicalenergy to the tissue. In graph (800), the RF electrosurgical energy isrepresented by the line (802) with spaced apart circles. As noted aboveand as shown in FIG. 12, this RF electrosurgical energy provides a rapidincrease in the tissue temperature (602), resulting in the tissue (T₁,T₂) beginning to seal relatively quickly after the control algorithm isfirst executed. So again, the tissue (T₁, T₂) will begin to seal muchmore quickly when RF electrosurgical energy is used at the beginning ofthe process as compared to just ultrasonic energy.

Unlike the algorithm shown in graph (500) of FIG. 11, the algorithmshown in graph (800) provides a sustained combination of RFelectrosurgical energy and ultrasonic energy. In graph (800), theultrasonic energy is represented by the line (804) with spaced apartx's. The moment at which this power mode transition occurs isrepresented by line (806) in graph (800) of FIG. 14. In some versions,this moment represented by line (806) in graph (800) of FIG. 14 maycoincide with the moment represented by line (604) in graph (600) ofFIG. 12. In other words, control module (256) may toggle from only RFelectrosurgical energy to a combination of RF electrosurgical energy andultrasonic energy once the tissue temperature (602) passes a firstthreshold level (610) that is just below the level (612) where tissuesealing actually begins. In some other versions, the moment representedby line (806) in graph (800) of FIG. 14 may coincide with the momentrepresented by line (606) in graph (600) of FIG. 12. In other words,control module (256) may toggle from only RF electrosurgical energy to acombination of RF electrosurgical energy and ultrasonic energy once thetissue temperature (602) reaches the level (612) where tissue sealingactually begins.

As noted above, the tissue (T₁, T₂) will be actively sealed during thetime period between the moments represented by lines (606, 608). As alsonoted above and as shown in FIG. 12, the tissue temperature (602)remains substantially constant, at the level (612) associated withsealing, during this time period. In some versions, control module (256)may regulate the combined delivery of RF electrosurgical energy andultrasonic power through end effector (300, 400) in order to provideconstancy in the tissue temperature (602) during this period. In somesuch versions, control module (256) relies on feedback from sensor (340,440) in order to regulate the combined delivery of RF electrosurgicalenergy and ultrasonic power through end effector (300, 400) in order toprovide constancy in the tissue temperature (602). By way of exampleonly, control module (256) may raise or lower the power level of the RFelectrosurgical energy and/or raise or lower the ultrasonic power levelduring the time period between the moments represented by lines (606,608), based ion data from sensor (340, 440), in order to provideconstancy in the tissue temperature (602). As another merelyillustrative example, control module (256) may determine whether RFelectrosurgical energy or ultrasonic energy is the most appropriatepower mode for a particular moment during the time period between themoments represented by lines (606, 608), and switch between these powermodes accordingly, based on data from sensor (340, 440).

IV. EXEMPLARY COMBINATIONS

The following examples relate to various non-exhaustive ways in whichthe teachings herein may be combined or applied. It should be understoodthat the following examples are not intended to restrict the coverage ofany claims that may be presented at any time in this application or insubsequent filings of this application. No disclaimer is intended. Thefollowing examples are being provided for nothing more than merelyillustrative purposes. It is contemplated that the various teachingsherein may be arranged and applied in numerous other ways. It is alsocontemplated that some variations may omit certain features referred toin the below examples. Therefore, none of the aspects or featuresreferred to below should be deemed critical unless otherwise explicitlyindicated as such at a later date by the inventors or by a successor ininterest to the inventors. If any claims are presented in thisapplication or in subsequent filings related to this application thatinclude additional features beyond those referred to below, thoseadditional features shall not be presumed to have been added for anyreason relating to patentability.

Example 1

An apparatus comprising: (a) a body; (b) a shaft assembly, wherein theshaft assembly extends distally from the body, wherein the shaftassembly comprises an acoustic waveguide, wherein the waveguide isconfigured to acoustically couple with an ultrasonic transducer; (c) anend effector, wherein the end effector comprises: (i) an ultrasonicblade in acoustic communication with the waveguide, (ii) a clamp arm,wherein the clamp arm is operable to compress tissue against theultrasonic blade, (iii) an electrode, wherein the electrode is operableto apply radiofrequency (RF) electrosurgical energy to tissue, and (iv)a sensor, wherein the sensor is operable to sense a condition of tissuecontacted by the end effector; and (d) a control module, wherein thecontrol module is operable to control delivery of ultrasonic power andRF electrosurgical energy through the end effector based on data fromthe sensor.

Example 2

The apparatus of Example 1, wherein the control module is configured to:(i) first, activate the end effector to apply only RF electrosurgicalenergy to tissue captured between the clamp arm and the ultrasonicblade, and (ii) second, activate the end effector to apply ultrasonicenergy to tissue captured between the clamp arm and the ultrasonic bladeafter the RF electrosurgical energy has been applied.

Example 3

The apparatus of Example 2, wherein the control module is configured toautomatically transition from activating the end effector to apply onlyRF electrosurgical energy to tissue to activating the end effector toapply ultrasonic energy to tissue based on data from the sensor.

Example 4

The apparatus of Example 3, wherein the control module is configured toautomatically transition from activating the end effector to apply onlyRF electrosurgical energy to tissue to activating the end effector toapply ultrasonic energy to tissue based on data from the sensorindicating that the tissue has reached a certain temperature.

Example 5

The apparatus of any one or more of Examples 2 through 4, wherein thecontrol module is configured to automatically cease activation of theend effector to apply only RF electrosurgical energy to tissue when thecontrol module activates the end effector to apply ultrasonic energy totissue, such that the end effector only applies ultrasonic energy totissue after only applying RF electrosurgical energy to tissue.

Example 6

The apparatus of Example 1, wherein the control module is configured to:(i) first, activate the end effector to apply only RF electrosurgicalenergy to tissue captured between the clamp arm and the ultrasonicblade, and (ii) second, activate the end effector to apply a combinationof RF electrosurgical energy and ultrasonic energy to tissue capturedbetween the clamp arm and the ultrasonic blade after the RFelectrosurgical energy has been applied.

Example 7

The apparatus of Example 6, wherein the control module is configured toautomatically transition from activating the end effector to apply onlyRF electrosurgical energy to tissue to activating the end effector toapply a combination of RF electrosurgical energy and ultrasonic energyto tissue based on data from the sensor.

Example 8

The apparatus of any one or more of Examples 6 through 7, wherein thecontrol module is further configured to, third, apply only ultrasonicenergy to tissue captured between the clamp arm and the ultrasonic bladeafter the combination of RF electrosurgical energy and ultrasonic energyhas been applied.

Example 9

The apparatus of Example 8, wherein the control module is furtherconfigured to modulate between applying ultrasonic energy and RFelectrosurgical energy in order to provide a substantially constanttissue temperature.

Example 10

The apparatus of any one or more of Examples 1 through 9, wherein theelectrode is integrated into the clamp arm.

Example 11

The apparatus of any one or more of Examples 1 through 10, wherein theelectrode and the ultrasonic blade are configured to cooperate to applybipolar RF electrosurgical energy to tissue.

Example 12

The apparatus of any one or more of Examples 1 through 11, wherein thesensor is integrated into the clamp arm.

Example 13

The apparatus of any one or more of Examples 1 through 12, wherein thesensor comprises a temperature sensor.

Example 14

The apparatus of any one or more of Examples 1 through 13, wherein thesensor comprises an impedance sensor.

Example 15

The apparatus of any one or more of Examples 1 through 14, wherein thesensor comprises a positive temperature coefficient (PTC) thermistor.

Example 16

An apparatus comprising: (a) a body; (b) a shaft assembly, wherein theshaft assembly extends distally from the body, wherein the shaftassembly comprises an acoustic waveguide, wherein the waveguide isconfigured to acoustically couple with an ultrasonic transducer; (c) anend effector, wherein the end effector comprises: (i) an ultrasonicblade in acoustic communication with the waveguide, and (ii) a clamparm, wherein the clamp arm is operable to compress tissue against theultrasonic blade, wherein the clamp arm and the ultrasonic blade areoperable to cooperate to apply bipolar radiofrequency (RF)electrosurgical energy to tissue; (d) a sensor, wherein the sensor isoperable to sense a condition of tissue contacted by the end effector;and (e) a control module, wherein the control module is operable to: (i)activate the end effector to pre-heat tissue with RF electrosurgicalenergy in a pre-heating stage, (ii) activate the end effector to sealtissue with ultrasonic energy in a sealing stage, and (iii)automatically transition from the pre-heating stage to the sealing stagebased on data from the sensor.

Example 17

A method of sealing tissue, comprising: (a) applying radiofrequency (RF)electrosurgical energy to tissue to thereby pre-heat the tissue; (b)sensing a condition associated with the temperature of the tissue whileperforming the act of applying RF electrosurgical energy to the tissue;(c) detecting a condition indicating that the temperature of the tissuehas reached a predetermined level; and (d) applying ultrasonic energy tothe tissue to seal the tissue, wherein the act of applying ultrasonicenergy to the tissue is initiated based on the act of detecting thecondition indicating that the temperature of the tissue has reached thepredetermined level.

Example 18

The method of Example 17, further comprising ceasing the act of applyingradiofrequency (RF) electrosurgical energy to tissue in response to theact of detecting the condition indicating that the temperature of thetissue has reached the predetermined level.

Example 19

The method of Example 17, wherein the act of applying radiofrequency(RF) electrosurgical energy continues to be performed during performanceof the act of applying ultrasonic energy to the tissue to seal thetissue.

Example 20

The method of Example 17, wherein the act of applying radiofrequency(RF) electrosurgical energy continues to be performed for a first periodduring performance of the act of applying ultrasonic energy to thetissue to seal the tissue, wherein the act of applying radiofrequency(RF) electrosurgical energy ceases during a second period duringperformance of the act of applying ultrasonic energy to the tissue toseal the tissue.

Example 21

A method of sealing tissue, comprising: (a) applying radiofrequency (RF)electrosurgical energy to tissue via an end effector to thereby pre-heatthe tissue; and (b) automatically applying ultrasonic energy to thepre-heated tissue via the end effector to thereby seal the pre-heatedtissue, wherein the act of automatically applying ultrasonic energy tothe pre-heated tissue via the end effector is initiated upon passage ofa predetermined period of time after the act of applying RFelectrosurgical energy is initiated.

Example 22

The method of Example 21, further comprising ceasing the act of applyingRF electrosurgical energy to the tissue upon passage of thepredetermined period of time.

V. MISCELLANEOUS

It should be understood that any of the versions of instrumentsdescribed herein may include various other features in addition to or inlieu of those described above. By way of example only, any of theinstruments described herein may also include one or more of the variousfeatures disclosed in any of the various references that areincorporated by reference herein. It should also be understood that theteachings herein may be readily applied to any of the instrumentsdescribed in any of the other references cited herein, such that theteachings herein may be readily combined with the teachings of any ofthe references cited herein in numerous ways. Other types of instrumentsinto which the teachings herein may be incorporated will be apparent tothose of ordinary skill in the art.

It should also be understood that any ranges of values referred toherein should be read to include the upper and lower boundaries of suchranges. For instance, a range expressed as ranging “betweenapproximately 1.0 inches and approximately 1.5 inches” should be read toinclude approximately 1.0 inches and approximately 1.5 inches, inaddition to including the values between those upper and lowerboundaries.

It should be appreciated that any patent, publication, or otherdisclosure material, in whole or in part, that is said to beincorporated by reference herein is incorporated herein only to theextent that the incorporated material does not conflict with existingdefinitions, statements, or other disclosure material set forth in thisdisclosure. As such, and to the extent necessary, the disclosure asexplicitly set forth herein supersedes any conflicting materialincorporated herein by reference. Any material, or portion thereof, thatis said to be incorporated by reference herein, but which conflicts withexisting definitions, statements, or other disclosure material set forthherein will only be incorporated to the extent that no conflict arisesbetween that incorporated material and the existing disclosure material.

Versions of the devices described above may have application inconventional medical treatments and procedures conducted by a medicalprofessional, as well as application in robotic-assisted medicaltreatments and procedures. By way of example only, various teachingsherein may be readily incorporated into a robotic surgical system suchas the DAVINCI™ system by Intuitive Surgical, Inc., of Sunnyvale, Calif.Similarly, those of ordinary skill in the art will recognize thatvarious teachings herein may be readily combined with various teachingsof U.S. Pat. No. 6,783,524, entitled “Robotic Surgical Tool withUltrasound Cauterizing and Cutting Instrument,” published Aug. 31, 2004,the disclosure of which is incorporated by reference herein.

Versions described above may be designed to be disposed of after asingle use, or they can be designed to be used multiple times. Versionsmay, in either or both cases, be reconditioned for reuse after at leastone use. Reconditioning may include any combination of the steps ofdisassembly of the device, followed by cleaning or replacement ofparticular pieces, and subsequent reassembly. In particular, someversions of the device may be disassembled, and any number of theparticular pieces or parts of the device may be selectively replaced orremoved in any combination. Upon cleaning and/or replacement ofparticular parts, some versions of the device may be reassembled forsubsequent use either at a reconditioning facility, or by an operatorimmediately prior to a procedure. Those skilled in the art willappreciate that reconditioning of a device may utilize a variety oftechniques for disassembly, cleaning/replacement, and reassembly. Use ofsuch techniques, and the resulting reconditioned device, are all withinthe scope of the present application.

By way of example only, versions described herein may be sterilizedbefore and/or after a procedure. In one sterilization technique, thedevice is placed in a closed and sealed container, such as a plastic orTYVEK bag. The container and device may then be placed in a field ofradiation that can penetrate the container, such as gamma radiation,x-rays, or high-energy electrons. The radiation may kill bacteria on thedevice and in the container. The sterilized device may then be stored inthe sterile container for later use. A device may also be sterilizedusing any other technique known in the art, including but not limited tobeta or gamma radiation, ethylene oxide, or steam.

Having shown and described various embodiments of the present invention,further adaptations of the methods and systems described herein may beaccomplished by appropriate modifications by one of ordinary skill inthe art without departing from the scope of the present invention.Several of such potential modifications have been mentioned, and otherswill be apparent to those skilled in the art. For instance, theexamples, embodiments, geometrics, materials, dimensions, ratios, steps,and the like discussed above are illustrative and are not required.Accordingly, the scope of the present invention should be considered interms of the following claims and is understood not to be limited to thedetails of structure and operation shown and described in thespecification and drawings.

1-22. (canceled)
 23. An ultrasonic surgical instrument, comprising: (a)an end effector, including: (i) an ultrasonic blade configured toconnect to an acoustic waveguide for acoustic communication of anultrasonic energy to the ultrasonic blade for applying to a tissue, (ii)a first electrode configured to receive a radiofrequency (RF)electrosurgical energy for applying to the tissue, (iii) a sensorconfigured to sense a first condition of the tissue; and (b) a controlmodule operatively connected to the ultrasonic blade, the firstelectrode and the sensor, wherein the control module has a control logicwith a first predetermined tissue condition level residing thereon,wherein the control logic is configured to receive the first conditionof the tissue from the sensor and determine when the first condition hasreached the first predetermined condition level such that the controlmodule adjusts activation of at least one of the ultrasonic or RFelectrosurgical energies from the ultrasonic blade or first electrode,respectively, in response to the first condition reaching the firstpredetermined condition level.
 24. The ultrasonic surgical instrument ofclaim 23, wherein the first electrode is incorporated into theultrasonic blade.
 25. The ultrasonic surgical instrument of claim 23,wherein the end effector further includes a clamp arm movably mountedrelative to the ultrasonic blade and configured to compress the tissueagainst the ultrasonic blade.
 26. The ultrasonic surgical instrument ofclaim 25, wherein the first electrode is secured to the clamp arm. 27.The ultrasonic surgical instrument of claim 26, wherein the end effectorfurther includes a second electrode, and wherein the second electrode issecured to the clamp arm.
 28. The ultrasonic surgical instrument ofclaim 25, wherein the sensor is secured to the clamp arm.
 29. Theultrasonic surgical instrument of claim 23, wherein the sensor isincorporated into the ultrasonic blade.
 30. The ultrasonic surgicalinstrument of claim 23, wherein the sensor is incorporated into thefirst electrode.
 31. The ultrasonic surgical instrument of claim 23,wherein the sensor includes a temperature sensor.
 32. The ultrasonicsurgical instrument of claim 23, wherein the sensor includes animpedance sensor.
 33. The ultrasonic surgical instrument of claim 23,wherein the sensor includes a positive temperature coefficientthermistor.
 34. The ultrasonic surgical instrument of claim 23, whereinthe sensor includes an optical sensor.
 35. The ultrasonic surgicalinstrument of claim 23, wherein the first condition of the tissue is afirst temperature of the tissue, wherein the first predetermined tissuecondition level is a first predetermined tissue temperature level, andwherein the control module is configured to activate the end effector toapply only RF electrosurgical energy prior to the control moduledetermining that the tissue has reached the first temperature forpre-heating the tissue with the RF electrosurgical energy.
 36. Theultrasonic surgical instrument of claim 35, wherein the control moduleis further configured to adjust the activation of at least one of theultrasonic or electrosurgical energies from the ultrasonic blade orfirst electrode, respectively, in response to the first temperature ofthe tissue reaching the first predetermined tissue temperature levelsuch that the control module activates at least the ultrasonic energy.37. The ultrasonic surgical instrument of claim 36, wherein the controlmodule is further configured to regulate activation at least one of theultrasonic or RF electrosurgical energies from the ultrasonic blade orfirst electrode in response to the first temperature of the tissuereaching the first predetermined tissue temperature level to therebyprovide consistency of the first temperature of the tissue at the firstpredetermined tissue temperature level.
 38. An ultrasonic surgicalinstrument, comprising: (a) an end effector, including: (i) anultrasonic blade configured to connect to an acoustic waveguide foracoustic communication of an ultrasonic energy to the ultrasonic bladefor applying to a tissue, (ii) a first electrode configured to receive aradiofrequency (RF) electrosurgical energy for applying to the tissue,(iii) a sensor configured to sense a first condition of the tissue; and(b) a control module operatively connected to the ultrasonic blade, thefirst electrode and the sensor, wherein the control module has a controllogic with a first predetermined tissue temperature level residingthereon, wherein the control logic is configured to receive the firstcondition of the tissue from the sensor and determine a firsttemperature of the tissue based on the first condition, and wherein thecontrol logic is further configured to determine that the firsttemperature of the tissue is below the first predetermined tissuetemperature level such that the control module activates the endeffector with only RF electrosurgical energy for pre-heating the tissue.39. The ultrasonic surgical instrument of claim 38, wherein the controlmodule is further configured to determine when the first temperature hasreached the first predetermined temperature level such that the controlmodule activates at least the ultrasonic energy in response to the firsttemperature of the tissue reaching the first predetermined temperaturelevel.
 40. The ultrasonic surgical instrument of claim 38, wherein thefirst electrode is incorporated into the ultrasonic blade.
 41. Theultrasonic surgical instrument of claim 38, wherein the sensor isincorporated into the ultrasonic blade.
 42. A method of pre-heating atissue with an ultrasonic surgical instrument, the ultrasonic surgicalinstrument including: (a) an end effector, including: (i) an ultrasonicblade configured to connect to an acoustic waveguide for acousticcommunication of an ultrasonic energy to the ultrasonic blade forapplying to a tissue, (ii) a first electrode configured to receive aradiofrequency (RF) electrosurgical energy for applying to the tissue,(iii) a sensor configured to sense a first condition of the tissue; and(b) a control module operatively connected to the ultrasonic blade, thefirst electrode and the sensor, wherein the control module has a controllogic with a first predetermined tissue condition level residingthereon, wherein the control logic is configured to receive the firstcondition of the tissue from the sensor and determine when the firstcondition has reached the first predetermined condition level such thatthe control module adjusts activation of at least one of the ultrasonicor RF electrosurgical energies from the ultrasonic blade or firstelectrode, respectively, in response to the first condition reaching thefirst predetermined condition level, the method comprising: (a)activating the end effector with only RF electrosurgical energy to applyfor pre-heating the tissue; (b) determining that the first condition hasreached the first predetermined condition level; and (c) adjustingactivation of at least one of the ultrasonic or RF electrosurgicalenergies from the ultrasonic blade or first electrode, respectively, inresponse to the first condition reaching the first predeterminedcondition level.